Comparing Western symptoms of depression with Arabic idioms of distress: A qualitative study


Psychometric analyses of different rating scales have shown that the construct validity of depression in relation to patients from other cultural backgrounds than Western is unclear. This calls for more knowledge on the qualitative properties of depression in a transcultural context. The aim of the study was to examine how Arabic speaking patients understand and speak about mental distress, while also exploring to what degree they find depressive symptoms as defined in the ICD-10 and selected rating scales meaningful. Six semi-structured interviews with Arabic speaking patients from Syria, Lebanon and Iraq receiving treatment at a Danish treatment centre were conducted. Data was analysed by the use of thematic analysis. Various Arabic terms in relation to a state comparable to depression were obtained, especially in relation to the core depressive symptoms of “low mood”, “low energy” and “loss of interest”. Symptoms regarding guilt and loss of self-confidence were not recognized as a part of a depressive state to the same degree as the other depressive symptoms. Some symptoms, such as somatic complaints, were more accepted to speak openly about than others. It was concluded that the participants in the study generally recognized the depressive symptoms as defined in the ICD-10 and would use comparable Arabic terms to describe mental distress. However, cultural background may influence to what extend depression is accepted to speak about, which should thus be taken into consideration and addressed by mental health professionals. In a clinical setting, this knowledge can be used to include culture specific terms and phrases in the conversations with Arabic speaking patients.

This is a preview of subscription content, log in to check access.


  1. Al-Issa, I. (2000). Mental illness in medieval Islamic society. In In: Al-Junun, mental illness in the Islamic world. Madison: International Universities Press.

    Google Scholar 

  2. Bagby, R. M., Ryder, A. G., Schuller, D. R., & Marshall, M. B. (2004). The Hamilton depression rating scale: Has the gold standard become a Lead weight? American Journal of Psychiatry, 161(12), 2163–2177

    Article  Google Scholar 

  3. Bech, P. (2011). The ABC profile of the HAM-D17. Revista brasileira de psiquiatria (São Paulo, Brazil : 1999), 33, 109–110

    Article  Google Scholar 

  4. Bener, A., & Ghuloum, S. (2011). Gender differences in the knowledge, attitude and practice towards mental health illness in a rapidly developing Arab society. International Journal of Social Psychiatry, 57(5), 480–486

    Article  Google Scholar 

  5. Bracken, P., Giller, J., & Summerfield, D. (1995). Psychological responses to war and atrocity: The limitations of current concepts. Social Science & Medicine, 40(8), 1073–1082

    Article  Google Scholar 

  6. Braun, V., & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3(2), 77–101

    Article  Google Scholar 

  7. Burr, V. (2015). Social constructionism. London, UNITED KINGDOM: Routledge.

    Google Scholar 

  8. Caroppo, E., Muscelli, C., Brogna, P., Paci, M., Camerino, C., & Bria, P. (2009). Relating with migrants: Ethnopsychiatry and psychotherapy. Annali dell Istituto Superiore di Sanita, 45(3), 331–340.

    PubMed  Google Scholar 

  9. El-Islam, M. F. (1982). Arabic cultural psychiatry. Transcultural Psychiatric Research Review, 19(1), 5–24

    Article  Google Scholar 

  10. Eurostat (2020, April 2nd): Asylum and first time asylum applicants by citizenship, age and sex. Annual aggregated data (rounded). Retrieved April 17th 2020 from:,C,X,0;GEO,L,Y,0;CITIZEN,L,Z,0;SEX,L,Z,1;AGE,L,Z,2;ASYL_APP,L,Z,3;UNIT,L,Z,4;INDICATORS,C,Z,5;&zSelection=DS-057066CITIZEN,EXT_EU28;DS-057066UNIT,PER;DS-057066ASYL_APP,NASY_APP;DS-057066INDICATORS,OBS_FLAG;DS-057066SEX,T;DS-057066AGE,Y_LT18;&rankName1=UNIT_1_2_-1_2&rankName2=AGE_1_2_-1_2&rankName3=CITIZEN_1_2_-1_2&rankName4=INDICATORS_1_2_-1_2&rankName5=ASYL-APP_1_2_-1_2&rankName6=SEX_1_2_-1_2&rankName7=TIME_1_0_0_0&rankName8=GEO_1_2_0_1&sortC=ASC_-1_FIRST&rStp=&cStp=&rDCh=&cDCh=&rDM=true&cDM=true&footnes=false&empty=false&wai=false&time_mode=ROLLING&time_most_recent=false&cfo=%23%23%23%2C%23%23%23.%23%23%23&lang=en.

  11. Haroz, E. E., Ritchey, M., Bass, J., Kohrt, B. A., Augustinavicius, J., Michalopoulos, L., et al. (2017). How is depression experienced around the world? A systematic review of qualitative literature. Social Science & Medicine, 183, 151–162

    Article  Google Scholar 

  12. Islam, F., & Campbell, R. (2014). “Satan has afflicted me!” jinn-possession and mental illness in the Qur’an. Journal of Religion and Health, 53(1), 229–243

    Article  Google Scholar 

  13. Kaiser, B., Haroz, E. E., Kohrt, B. A., Bolton, P. A., Bass, J., & Hinton, D. (2015). “Thinking too much”: A systematic review of a common idiom of distress. Social Science & Medicine, 147, 170–183

    Article  Google Scholar 

  14. Killikelly, C., & Maercker, A. (2018). Prolonged grief disorder for ICD-11: The primacy of clinical utility and international applicability. European Journal of Psychotraumatology, 8(6), 1–9

    Google Scholar 

  15. Kirmayer, L. J. (1984). Culture, affect and somatization: Part I. Transcultural Psychiatric Research Review, 21(3), 159–188

    Article  Google Scholar 

  16. Kirmayer, L. J. (1989). Cultural variations in the response to psychiatric disorders and emotional distress. Social Science & Medicine, 29(3), 327–339

    Article  Google Scholar 

  17. Kirmayer, L. J. (2001). Cultural variations in the clinical presentation of depression and anxiety: Implications for diagnosis and treatment. The Journal of Clinical Psychiatry, 62(suppl 13), 22–28.

    PubMed  Google Scholar 

  18. Kirmayer, L. J. (2007). Cultural psychiatry in historical perspective. In: D. Bhugra & K. Bhui (red.), Textbook of cultural psychiatry (pp. 3–19).

  19. Kirmayer, L. J., & Young, A. (1998). Culture and somatization: Clinical, epidemiological, and ethnographic perspectives. Psychosomatic Medicine, 60(4), 420–430.

    Article  Google Scholar 

  20. Klass, D. (2013). Sorrow and solace: Neglected areas in bereavement research. Death Studies, 37(7), 597–616

    Article  Google Scholar 

  21. Kleinman, A. (1977). Depression, somatization and the “new cross-cultural psychiatry”. Social Science & Medicine (1967), 11(1), 3–9

    Article  Google Scholar 

  22. Kleinman, A. (1980). Patients and healers in the context of culture, an exploration of the borderland between anthropology, medicine, and psychiatry. Berkeley, Calif: University of California Press.

    Google Scholar 

  23. Kleinman, A. (1991). Rethinking psychiatry, from cultural category to personal experience (Paperback ed.). New York: Free Press.

    Google Scholar 

  24. Marsella, A., J., Sartorius, N., Jablensky, A., & Fenton, F., R. (1985). Cross-cultural studies of depressive disorders: An overview. In: A. Kleinman & B. Good, Culture and depression, studies in the anthropology and cross-cultural psychiatry of affect and disorder (pp. 299–323). Berkeley, Calif: University of California Press.

  25. Ministry of Immigration and Integration. (2018, January 3rd ). Danmark fik i 2017 det laveste antal asylansøgere i ni år—Udlændinge- og Integrationsministeriet. Retrieved March 19th 2019 from:

  26. Mollica, R. F., Caspi-Yavin, Y., Bollini, P., Truong, T., Tor, S., & Lavelle, J. (1992). The Harvard trauma questionnaire. Validating a cross-cultural instrument for measuring torture, trauma, and posttraumatic stress disorder in Indochinese refugees. The Journal of Nervous and Mental Disease, 180(2), 111–116.

    Article  Google Scholar 

  27. Rasmussen, A., Keatley, E., & Joscelyne, A. (2014). Posttraumatic stress in emergency settings outside North America and Europe: A review of the emic literature. Social Science & Medicine, 109, 44–54

    Article  Google Scholar 

  28. Sayed, M. (2003). Conceptualization of mental illness within Arab cultures: Meeting challenges in cross-cultural settings. Social Behavior and Personality, 31(4), 333–342

    Article  Google Scholar 

  29. Scheper-Hughes, N., & Lock, M. M. (1987). The mindful body: A prolegomenon to future work in medical anthropology. In Medical anthropology quarterly, 1(1), 6–41 (Vol. 1, pp. 6–41). Retrieved from: JSTOR.

    Google Scholar 

  30. Statistics Denmark (n.d.): Asylansøgere efter asyltype, statsborgerskab og tid. Retrieved April 2nd 2020 from:

  31. Sulaiman, S. O. Y., Bhugra, D., & de Silva, P. (2001). The development of a culturally sensitive symptom checklist for depression in Dubai. Transcultural Psychiatry, 38(2), 219–229

    Article  Google Scholar 

  32. Turrini, G., Purgato, M., Ballette, F., Nosè, M., Ostuzzi, G., & Barbui, C. (2017). Common mental disorders in asylum seekers and refugees: Umbrella review of prevalence and intervention studies. International Journal of Mental Health Systems, 11(1), 1–14

    Article  Google Scholar 

  33. White, G. M. (1992). Ethnopsychology. In: T. Schwartz, G. M. White, & C. A. Lutz (red.), New directions in psychological anthropology (pp. 21–46). Cambridge: Cambridge University press.

  34. World Health Organization. (n.d.). ICD-10 Version:2016. Retrieved December 26th 2018 from:

Download references

Author information



Corresponding author

Correspondence to Hanke Vink.

Ethics declarations

Conflict of Interest

The authors declare that they have no conflict of interest.

Ethics Approval

All procedures performed in the study involving human participants were in acccordance with the ethical standards of the institutional and national research committee.

Ethics approval was not obtained for the study since the study was of a qualitative nature (interviews) and did not include human biological material. Under these circumstances, ethics approval is not required in Denmark. See link:

In the link, it is described that questionnaires and interviews should not be notified to a research ethics committee.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Vink, H., Carlsson, J., Poulsen, S. et al. Comparing Western symptoms of depression with Arabic idioms of distress: A qualitative study. Curr Psychol (2020).

Download citation


  • Transcultural psychiatry
  • Idioms of distress
  • Local concepts
  • Mental health
  • Mental disorder
  • Depression